The report, titled "The Health Impacts of Gambling Expansion in Toronto", concluded that a new Toronto casino will increase the risk of problem gambling and exacerbate its serious public health impacts.

The sixteen-minute interview is definitely worth watching:

In the interview, Paiken asks how gambling falls under the purview of public health, and Dr McKeown explains that problem gambling leads to health problems: anxiety, depression, family breakdown, and poverty.

McKeown notes that the evidence of problem gambling strongly indicates, "There's a very clear relationship between how convenient it is to gamble and the proportion of the population that are going to be problem gamblers."

He also points out that the presence of a nearby physical casino is a much bigger indicator of problem gambling than access to online gambling, which is already widespread.

Internet gambling, although it's widely available, turns out to be one of the least common forms of gambling - at least, the kind that lead to problem gambling. Most problem gamblers that seek clinincal treatment, for example, have trouble with slot machines and table games - exactly the kind of things that you find in a casino. And the closer to a casino, the more convenient it is, the more likely people are to gamble in a way that causes health problems.

The interview also covers the ten recommendations McKeown makes if a casino does come to Toronto:

Limit hours of operation

Restrict number of slot machines and slow the speed of play

Eliminate casino loyalty programs

Prohibit ATMs on gambling floor

Prohibit casino credit/holding accounts

Reduce maximum bet size

Mandate daily loss maximum

Implement mandatory player card system

Issue monthly individual patron activity reports

Designate areas for alcohol purchase away from casino floors

Paikin focuses in on the idea of a mandatory player card system. McKeown argues that this allows players to self-exclude by telling the casino not to allow them to play. It also allows the ability to limit how much people can spend in a given time period.

It also allows the casino to send monthly reports to players so they can see how much they are spending vs. winning. This, in turn, helps players to recognize the essential mathematical fact of casinos: the more you play, the more you lose. The casino is specifically set up to take in more money than it pays out, so more gambling translates directly into more losses.

Asked to pick which of these recommendations is the most important, McKeown replies:

The number one item on that list, really, is not to expand access to gambling. People often go straight to the top ten, skipping that one. Better not to have a casino than to have a casino, even with all of these safeguards in place.

McKeown also points out that most of these safeguards are not in place in Ontario casinos, and he calls out special attention to loyalty programs - like the loyalty program operated by Ontario Lottery and Gaming Corporation (OLG) - as a major incentive for problem gamblers to continue gambling.

McKeown spares no punches in his commentary:

One of the reasons I think casino operators are reluctant to implement these measures is because they will effectively deter problem gamblers from spending money, and problem gamblers contribute a disproportionate amount of the profits that come from casinos.

It's important to note that Paikin is not a softball interviewer. He directly challenges McKeown on whether it makes sense to limit access to gambling to most people based on risk of harm to a small percentage. McKeown acknowledges that the Toronto City Council decision on a casino is not only a public health issue, but that the public health implications of the decision should be taken into account.

Asked about an analogy to alcohol sales, McKeown notes that access to alcohol is restricted in Ontario in part to ensure that alcohol is not sold to minors or to people who are already inebriated.

Paikin challenges McKeown: "you want to deny [gambling] for 99 percent of the population who, like you, does it irregularly and for fun."

McKeown responds that he is not proposing denying gambling, but rather applying evidence-based public health principles to the location and regulation of a casino. "We want to set the conditions in place to minimize the harm done for people who are prone to problem gambling. ... I think it's a reasonable trade-off: inconvenience for people who are going to gamble in a healthy and safe way, versus limiting the damage, the very severe damage, that can be done for problem gamblers."

Update: This article originally read in part, "The interview also covers the ten recommendations McKeown makes if a casino does come to Hamilton", but McKeown was speaking to Jeff Paiken about a Toronto casino, not a Hamilton casino. RTH regrets the error. You can jump to the changed paragraph.

Ryan McGreal, the editor of Raise the Hammer, lives in Hamilton with his family and works as a programmer, writer and consultant. Ryan volunteers with Hamilton Light Rail, a citizen group dedicated to bringing light rail transit to Hamilton. Ryan writes a city affairs column in Hamilton Magazine, and several of his articles have been published in the Hamilton Spectator. He also maintains a personal website and has been known to post passing thoughts on Twitter @RyanMcGreal. Recently, he took the plunge and finally joined Facebook.

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"The interview also covers the ten recommendations McKeown makes if a casino does come to Hamilton"

But since Hamilton has absolutely no say in the operation (or location, design, etc) of a casiNO, then unless the OLG adopts these recommendations throughout all of its casiNOs, then we won't see them here.

I vote down for offensiveness and up for humour. I cast no votes based on my level of agreement.

It seems ridiculous to me that politicians and bureaucrats are the ones attempting to ram casinos down our throats as a panacea for the fact that they can't get their spending habits and program creep under control, while other politicians and bureaucrats try to regulate the government prescribed solution to their own problem.

It should not be the states problem if you cannot control your gambling impulses. For that matter gambling, drinking, drugs.

You need to be an adult to do these things. That would indicate a certain level of personal responsibility and self awareness. Screw it up to your own detriment......... your problem. Hurt someone else, physcially, financially? Then it becomes someone else's business. The Police.